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'Public-Private' Health Law: Multiple Directions in Public Health

Public health law has been a quintessentially public law field, centered around a system of administrative agencies. In some respects, the field is moving even closer to the core of governmental functions. Since September 11, the 2001 anthrax attacks and Hurricane Katrina, the conceptual framework of emergency preparedness and response has subsumed ever larger segments of public health policymaking. Emergency planning has become an important discourse of governance, one which reveals a great deal about the operations of state power.

In this article, I identify three approaches to governance embedded in today's public health law and policy. The first and most traditional approach to governance is that of dominant state authority. What is notable is how this approach is being strengthened by a trend toward greater centralization and hierarchy in infectious disease control, pushing public health into a tighter command and control structure. I describe how this framing process has the effect of melding population health concerns and the security state, as well as insinuating a discourse of emergency response into non-emergency policy-making.

The second governance model in the public health field is the public-private administrative model. Although public-private models for administrative governance are relatively new to public health compared to many other fields, calls for partnerships with the private sector for the purpose of achieving population health goals are growing. Increasingly, private sector entities are implicated in the state's matrix of collaborative public health institutions.

The third governance construct is based on the insight from governmentality theory that the state already permeates the private sector even without formal authority; power flows back and forth between public and private entities through a multiplicity of channels and technologies. New federal proposals for "modern quarantine" provide an example. "Modern quarantine" policies would depend on the public's instinct to voluntarily sequester themselves in a pandemic, thus utilizing indirect and less coercive methods to control the spread of infectious disease. However, this proposal fails to engage with the full dimensions of the public sector role that would be necessary to enable people to remain at home for three months or more. It cannot succeed without mandates and incentives emanating from the state, a reality which official policy documents have elided.

From this analysis we can learn a great deal about both current directions in public health policy and about the utility and limitations of new governance theory. The three governance trends taken together exemplify a paradox fundamental to contemporary political debates: how the same apparatus can be intensifying as a security state while at the same time deploying new governance and privatization initiatives. The concept of modern quarantine demonstrates that serious complications lurk beneath the surface when policymakers engage in shallow invocations of new regulatory rhetoric.